Recommendations from others
The American Academy of Orthopaedic Surgeons’ clinical guideline for shoulder pain9 recommends the following for rotator cuff disease: avoidance of irritating activity; anti-inflammatory medications if tolerated; exercises to recover and maintain passive range of motion; exercises to strengthen the rotator cuff once acute symptoms abated. If these are unsuccessful over several weeks, they recommend considering subacromial injection of local anesthetic and a short-acting corticosteroid. They gave their recommendation a “B” rating (some evidence exists to suggest benefit).
CLINICAL COMMENTARY:
Consider injection with anesthetic and steroid for rotator cuff impingement
Sourav Poddar, MD
Team Physician, University of Colorado Buffaloes, University of Colorado Health Sciences Center, Denver
Subacromial injection is an integral component of the treatment armamentarium for certain types of shoulder pathology. Diagnostically, injection of a local anesthetic such as lidocaine can help differentiate true weakness caused by a full-thickness rotator cuff tear from inhibition due to inflammation and impingement pain. Strongly consider subacromial injection with both a local anesthetic and corticosteroid for patients with true rotator cuff impingement as diagnosed by positive Neer and Hawkins signs on examination.
If injection is appropriately administered, the patient should have near-immediate and significant reduction of impingement symptoms. They may regain motion sooner and advance quicker through their initial therapy program.